“Self-Interpreting Animals”: Making Sense of Pain that Haunts Daniel Kim, PhD(c) University of Chicago

The theme of this conference opens with a plain but fundamental observation: “Pain haunts human experience and frequently leads people to seek help from medical practitioners.” What is it to experience pain as a human being, and can it be a point of reference for thinking about an adequate medical response? In this presentation, I argue that the question requires us to make sense of the normativity of our nature as beings for whom things have a meaning within a field of meanings. In other words, we need a normative ontology of the self as what Charles Taylor calls “self-interpreting animals.”

I rely on Taylor’s distinction between the self-interpreting animal and the disengaged self to show how modern patient-centered medicine fails to grasp the significance of the meanings that constitute our experiences of pain. Patient-centered medicine is a philosophical stance committed to a particular conception of the person, namely, as a normative source of value, need, and preference. This ethic is sustained by an underlying picture of the self as essentially disengaged. On this self-image, “we think of our thoughts, ideas, or feelings as being ‘within us,’ while the objects in the world which these states bear on are ‘without.’” Our dignity is thus thought to consist in a disengaged freedom to define our own life-plan, free from all that would inhibit us.​The problem, however, is that such a self cannot make sense of meanings as anything more than instrumental to one’s self-defined goals--to one’s preferences as a disengaged subject of pain. Insofar as this self-image underlies medicine’s practices of caregiving and receiving, medicine cannot but miss our ordinary experiences of pain as that which “haunts” us. According to the medical anthropologist Arthur Kleinman, for example, pain haunts in that it threatens the things that matter to us or are meaningful to us as social beings, including in the religious sense. Such socio-religious meanings constitute the “local world” that we each inhabit and by which we come to be formed and form ourselves. In this sense, they are constitutive of nothing less than who we are or aspire to be.

To be sure, Kleinman rejects any normative ontology of the self, including Taylor’s. But I hope to show that clarity about such an ontology is necessary if medicine is to sustain itself as a practice capable of respecting our socio-religious experiences of pain in their proper significance to us—as constitutive of as opposed to instrumental to who we are or aspire to be.